The most important facet of a health insurance policy is its claim settlement process. Policyholders often want their insurance company to provide quick claim cover and hence ask, do hospitals offer claim settlement assistance in India?
To enjoy the maximum benefit from your health insurance policy, it’s mandatory to know the medical insurance claims processing steps. Hospitals offer two health insurance benefits- cashless and reimbursement claim settlement. Read on to learn about these in detail.
How Do I Claim Hospital Reimbursement?
Before filing the claim, it is advisable to know how to claim health insurance in India and the types of claims. The two types are-
Reimbursement claims: Firstly the insured have to pay the bills on their own and submit the health insurance claim settlement along with the documents to your insurance company. The reimbursement may take 15 to 30 days
Cashless claims: There is no need to pay the hospital bills by the policyholder (apart from a nominal amount) as the company will settle the bills after verifying all the details as the claim settlement if it’s a network hospital
The cashless claim is better than the reimbursement claim because of the convenience and benefits, but it works only if the insured is treated in the network hospital.
Medical Insurance Claims Processing Steps
The following steps are to be taken for processing medical claims:
Firstly, you have to inform the insurance company within the time limit specified in the policy document. In case of emergency hospitalisation, inform them within 24 hours
Provide all the necessary documents and their copies
Read and follow all the terms and conditions written on the policy documents while filing the claim form
The claim process completion takes up to a maximum of 45 days
Documents Required for Medi-claim Reimbursement
In cashless claims, the network hospital takes care of all the necessary details and documents. If filing for a reimbursement claim, the insured mainly needs to submit these list of documents:
Filled claim form: Either download it from the insurer’s website or get it at the hospital’s insurance desk
Medical reports and bills: Submit all the original medical bills and hospital reports
Discharge summary: Includes the details of the treatment taken and the given diagnosis
Prescription and medical certificate: The medical certificate confirming the hospitalisation and the doctor’s prescription
Policy documents: Keep the other documents asked by the insurer
After How Many Days Can We Claim Health Insurance?
According to the medical condition, type of policy and the insurer, the initial waiting period may vary. Usually, the cashless claim settlement time ranges from 30 to 90 days.
In case of an accident and emergency hospitalisation, an exception of a reduced waiting period is included.
Which Medical Insurance Has the Best Claim Settlement Process?
Several health insurance companies in India offer majestic health plans and services and the best deals on it to serve the needs of different people. Based on factors like claim settlement ratio (CSR), operational efficiencies, network hospitals, track records and ratings, you can choose which insurance company stands at the top position for you. Among the National Insurance Company and Oriental Assurance Company, HDFC Ergo, Care and Bajaj Allianz Life Insurance Company, there are others which have excellent CSR and ratings. The CSR keeps changing as per the received data. Also, some stand-alone health insurers are there which provide excellent services.
Conclusion
To conclude, this is the quick and important information on the claim settlement assistance offered by the hospitals. This should get you clear about the formalities made while going through a claim procedure.
